Nội dung Text: Encyclopedia.of.Medical.Anthropology-0306477548

Encyclopedia of
Medical Anthropology
Health and Illness in the World’s Cultures
Volume I: Topics
Volume II: Cultures
Edited by
Carol R. Ember
Human Relations Area Files at Yale University
New Haven, Connecticut
and
Melvin Ember
Human Relations Area Files at Yale University
New Haven, Connecticut
Published in conjunction with the Human Relations Area Files at Yale University
Kluwer Academic/Plenum Publishers
New York • Boston • Dordrecht • London • Moscow

Advisory Board
GEORGE ARMELAGOS Emory University
ELOIS ANN BERLIN University of Georgia
GAY BECKER University of California at San Francisco
PETER J. BROWN Emory University
C. H. BROWNER University of California, Los Angeles
JAMES W. CAREY Centers for Disease Control and Prevention
ALEX COHEN Harvard University
WILLIAM W. DRESSLER University of Alabama
ROBERT EDGERTON University of California, Los Angeles
RUTHBETH FINERMAN University of Memphis
LINDA C. GARRO University of California, Los Angeles
PAUL HOCKINGS University of Illinois at Chicago
LESLIE SUE LIEBERMAN University of Central Florida
MARGARET LOCK McGill University
LENORE MANDERSON University of Melbourne
MAC MARSHALL University of Iowa
JAMES J. MCKENNA University of Notre Dame
CARMELLA C. MOORE University of California, Irvine
ARTHUR J. RUBEL (deceased) University of California, Irvine
SUSAN C. WELLER University of Texas Medical Branch, Galveston
Managing Editor Jo-Ann Teadtke
The Encyclopedia of Medical Anthropology was prepared under the auspices and with the support of the Human
Relations Area Files, Inc. (HRAF) at Yale University. The foremost international research organization in the field of
cultural anthropology, HRAF is a not-for-profit consortium of 19 Sponsoring Member institutions and more than
400 active and inactive Associate Member institutions in nearly 40 countries. The mission of HRAF is to provide
information that facilitates the worldwide comparative study of human behavior, society, and culture. The HRAF
Collection of Ethnography, which has been building since 1949, contains nearly one million pages of information,
organized by culture and indexed according to more than 700 subject categories, on the cultures of the world. An
increasing portion of the Collection of Ethnography, which now covers more than 380 cultures, is accessible via the
World Wide Web to member institutions. The HRAF Collection of Archaeology, the first installment of which
appeared in 1999, is also accessible on the Web to member institutions. HRAF also prepares multivolume reference
works with the help of nearly 2,000 scholars around the world, and sponsors Cross-Cultural Research: The Journal
of Comparative Social Science.
v

Contributors
Thomas S. Abler, Department of Anthropology, University of Waterloo, Waterloo, Ontario
Rogaia Mustafa Abusharaf, Carr Center for Human Rights Policy, Kennedy School of Government, Harvard
University, Cambridge, Massachusetts
Steven Acheson, Archaeology Branch, Government of British Columbia, Victoria, British Columbia
Naomi Adelson, Department of Anthropology, York University, Toronto, Ontario
Pascale A. Allotey, Department of Public Health, University of Melbourne, Victoria, Australia
Hans A. Baer, Department of Anthropology, The George Washington University, Washington, D.C.
Eric J. Bailey, U.S. Department of Health & Human Services, National Institutes of Health, Bethesda, Maryland
Gay Becker, Department of Anthropology, History, and Social Medicine, University of California San Francisco, San
Francisco, California
Brent Berlin, Department of Anthropology, University of Georgia, Athens, Georgia
Elois Ann Berlin, Department of Anthropology, University of Georgia, Athens, Georgia
James R. Bindon, Department of Anthropology, University of Alabama, Tuscaloosa, Alabama
Astrid Blystad, Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway
Barry Bogin, Department of Behavioral Sciences, University of Michigan-Dearborn, Dearborn, Michigan
Erika Bourguignon, Professor Emerita, the Ohio State University, Columbus, Ohio
David J. Boyd, Department of Anthropology, University of California, Davis, Davis, California
George Brandon, Department of Behavioral Medicine, City University of New York, New York, New York
Rae Bridgman, Department of City Planning, University of Manitoba, Winnipeg, Manitoba
Leslie Butt, Department of Pacific and Asian Studies, University of Victoria, Victoria, British Columbia
James W. Carey, Prevention Research Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and
Prevention, Atlanta, Georgia
Gloria Castillo, Universidad de San Carlos, San Carlos, Guatemala
Arachu Castro, Department of Social Medicine, Harvard Medical School, Boston, Massachusetts
Dia Cha, Anthropology and Ethnic Studies, St. Cloud State University, St. Cloud, Minnesota
Alex Cohen, Department of Social Medicine, Harvard Medical School, Boston, Massachusetts
Jeannine Coreil, Department of Community and Family Health, University of South Florida, Tampa, Florida
Jay Bouton Crain, Department of Anthropology, California State University, Sacramento, California
Kathleen A. Culhane-Pera, Department of Family Practice and Community Medicine, University of Minneapolis,
Minneapolis, Minnesota
Allan Clifford Darrah, Department of Anthropology, California State University, Sacramento, California
Nancy Romero-Daza, Department of Anthropology, University of South Florida, Tampa, Florida
Erin Picone-DeCaro, Prevention Research Branch, Division of HIV/AIDS Prevention, Centers for Disease Control
and Prevention, Atlanta, Georgia
Linus S. Digim’Rina, Department of Anthropology and Sociology, University of Papua New Guinea, Papua, New
Guinea
vii

Preface
Illness and death are significant events for people everywhere. No one is spared. But medical beliefs and practices are
not the same everywhere. How people understand the causes of illness and death and how they cope with these events
vary from culture to culture. It is not surprising therefore that medical practitioners and others are becoming increas-
ingly aware of the need to understand the influence of society and culture on medical belief and practice. Culture—
the customary ways of thinking and acting in a society—often affects the outcome of illness, and even which illnesses
occur. So those who are actively engaged in studying health and illness are coming to realize that biological and
cultural factors need to be considered if we are to reduce human suffering.
The professional medicine of Western cultures has been called “biomedicine,” because it mostly deals with the
biology of the human body. But biomedicine, like the medicine of other cultures, is also influenced by conditions and
beliefs in the culture, and therefore reflects the value and norms of its creators. So, if biomedicine is socially
constructed and not just based on science, its beliefs and practices may partly derive from assumptions and biases in
the culture. For example, it used to be thought that some people refrained from drinking milk because they were igno-
rant. Now, biomedicine realizes that the avoidance of milk is a rational response to the likelihood that drinking milk
results in diarrhea and other discomforts in people who lack an enzyme (lactase) that allows easy digestion of the
sugar in milk (lactose). Anthropologists were the first to realize that drinking milk would cause serious problems for
many people. The anthropologists’ fieldwork in other cultures around the world revealed that people in many places
that have milking animals must sour the milk before they can drink it, to reduce or eliminate the sugar in it that would
otherwise make them sick.
Severe diarrhea may also be an effect of the culture’s system of social stratification. The direct causes of the
diarrhea may be biological, in the sense that the deaths are caused by bacterial or other infection. But why are so
many infants exposed to those infectious agents? Usually, the main reason is social or cultural. The affected infants
may mostly be poor. Because they are poor, they are likely to live with infected drinking water. Similarly, malnutri-
tion may be the biological result of a diet poor in protein. But such a diet is usually also a cultural phenomenon, reflect-
ing a society that has different classes of people, with very unequal access to the necessities of life, and unequal access
to decent medical care. For this and other reasons, medical anthropology is developing what has been called
a “biocultural synthesis” in its studies of health and illness.
Medical anthropology may even be in the forefront of the movement that is returning the entire field of anthro-
pology to its biocultural roots. In any case, the growth of jobs in medical anthropology is one of the more striking
developments in contemporary anthropology. Medical anthropology has developed into a very popular specialty, and
the Society for Medical Anthropology is now the second largest unit in the American Anthropological Association.
ORGANIZATION OF THIS ENCYCLOPEDIA
A total of 53 thematic and comparative essays begin these volumes. These essays are grouped into five sections: gen-
eral concepts and perspectives; medical systems; political, economic, and social issues; sexuality, reproduction, and the
life cycle; and health conditions and diseases. Then there are 52 cultural portraits of health and illness, articles that
describe the state of health and illness in 52 particular cultures around the world. Every cultural region of the world is
represented, as are cultures at all levels of social complexity. The Encyclopedia of Medical Anthropology is unique. In
addition to providing a large range of thematic essays, representing the various perspectives in medical anthropology,
these volumes are unique in focusing on so many particular cultures. No other single reference work comes close to
matching the depth and breadth of information on the varying cultural background of health and illness around the world.
We are able to provide the information contained here through the efforts of more than 100 contributors—generally
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xiv Preface
anthropologists but also other social scientists—who usually have firsthand experience with how medical cultures vary
around the world. Focusing on comparative topics and how health and illness are viewed and treated in the world’s
cultures is consistent with HRAF’s mission to encourage and facilitate comparative worldwide studies of human soci-
ety, culture, and behavior. Our aim is to leave the reader with a real sense of how different cultures deal with health and
illness, and what anthropology has contributed to understanding health and illness.
ORGANIZATION OF THE ARTICLES
The thematic and comparative essays vary in how they are organized, not just in their topics. The authors were encour-
aged by the editors to structure their discussions as they saw fit. On the other hand, the articles on health and illness
in particular cultures generally follow the same format to provide maximum comparability. That is, most of the cul-
ture articles cover the same topics, the list of which we developed with the help of our Advisory Board (see the head-
ings in boldface below). If there is substantial variation within the culture (e.g., by class or gender), the author was
instructed to note it where appropriate, either in a particular section or at the end. A heading may be omitted if infor-
mation on it is lacking or not applicable. The headings that follow are found in the vast majority of the articles to facil-
itate search and retrieval of information. Thus, the reader may easily compare how the cultures of the world differ and
are similar in the ways they deal with health and illness.
The outline for the culture articles includes the following topics.
Alternative Names of the Culture
Other names or ethnonyms used in the literature.
Location and Linguistic Affiliation
Where the described culture is located (region of the world, country and location within the country, where appropri-
ate). The language spoken by the people described, and the larger language family it belongs to.
Overview of the Culture
A summary of the culture to orient the reader, including information on demography, history, economy and occupa-
tions, social and political conditions, family and kinship, religion, etc.
The Context of Health: Environmental, Economic, Social, and Political Factors
This section first provides an overview of the health situation, with epidemiological statistics if available, or with
observer assessments if statistics are not available. Then there is a discussion of the global and local factors enhanc-
ing or detracting from health, including social factors (historical and colonial, if appropriate), the impact of diet and
nutrition (positive and negative), and the health infrastructure.
Medical Practitioners
Types of full-time and part-time practitioners in the society, and descriptions of their roles and the people they serve.
Classification of Illness, Theories of Illness, and Treatment of Illness
Discussion of the cultural understanding of illness (biomedical, other). Even where the biomedical paradigm is
accepted, there may be alternative viewpoints, which will be described. Mental illness will also be described in this

Preface xv
section. Discussions of age-related conditions (e.g., cardiovascular disease) will be reserved for the section on Health
Through the Life Cycle (see below).
Sexuality and Reproduction
Discussion of sexual attitudes and practices, and their impacts on health and fecundity and fertility, and other factors
affecting fecundity and fertility. Ideas about conception, ideal family size, and population controls and their conse-
quences (e.g., the effect of infertility on a woman’s status).
Health Through the Life Cycle
Pregnancy and Birth. Beliefs, attitudes, and practices relating to pregnancy, abortion, miscarriage, and birth.
Infancy. Postpartum practices, including breast-feeding. Reaction to multiple births, birth defects, treatment of the
healthy and unhealthy infant, and number and types of caretakers. Definitions of and duration of infancy. Special risks
for one gender as compared with another. Special protections against or treatments of illness in infancy.
Childhood. Care of children, ideas about discipline and length of childhood, if known, parental acceptance and
rejection, and cultural variation in concepts of child abuse. Special medical or health issues during this period.
Adolescence. If there is no apparent difference in treatment of adolescents as compared with children, this is
noted. Genital operations if any. Special medical or health issues during this period.
Adulthood. Special health or medical issues that come up in adulthood or that are related to marriage (e.g., domes-
tic abuse, unequal access by gender to medical care). Attitudes and practices regarding middle age (e.g., menopause)
are addressed here.
The Aged. Status and treatment of the aged. Discussion of the major medical problems of this age group.
Dying and Death. Treatment of the dying, concepts about death, reactions to it, and treatment of the body. Risks
to surviving spouses, if related to cultural practice (e.g., required suicide).
Changing Health Patterns (optional)
If changes over time have not been described in previous sections, this is where they will be described.
References
References to sources in the text are included to allow the reader to explore topics and cultures further.
USING THE ENCYCLOPEDIA OF MEDICAL ANTHROPOLOGY
This reference work can be used by a variety of people for a variety of purposes. It can be used both to gain a general
understanding of medical anthropology and to find out about particular cultures and topics. A bibliography is provided
at the end of each entry to facilitate further investigation.

xvi Preface
Beyond serving as a basic reference resource, the Encyclopedia of Medical Anthropology also serves readers with
more focused needs. For researchers interested in comparing cultures, this work provides information that can guide
the selection of particular cultures for further study. For those interested in international studies, the bibliographies in
each entry can lead one quickly to the relevant social science literature as well as provide a state-of-the-art assess-
ment of knowledge about medical cultures around the world. For curriculum developers and teachers seeking to inter-
nationalize the curriculum, this work is a basic reference and educational resource as well as a directory to other
materials. For government officials, it is a repository of information not likely to be available in any other single
publication; in many cases, the information provided here is not available at all elsewhere. For students, from high
school through graduate school, it provides background and bibliographic information for term papers and class
projects. And for travelers, it provides an introduction to the medical cultures of places they may be visiting.
ACKNOWLEDGMENTS
There are many people to thank for their contributions. Eliot Werner, formerly at Plenum, played an important role in
the planning of the project. The Advisory Board made valuable suggestions about the outline for the culture entries
and possible topics to be covered in the thematic essays, and suggested potential authors. The editors were responsi-
ble for the final selections of authors and for reviewing the manuscripts. For managing the project at HRAF, we are
indebted to Jo-Ann Teadtke. We thank Teresa Krauss for overseeing the production process at Kluwer/Plenum and
Tracy van Staalduinen for her efficient handling of the production of this Encyclopedia. Finally, and most of all, we
thank the contributors for their entries. Without their knowledge and commitment, this work would not have been pos-
sible.
Carol R. Ember, Executive Director
Melvin Ember, President
Human Relations Area Files at Yale University